Influenze tra processo ed esiti: alleanza, coesione e cambiamento in un gruppo terapeutico a lungo termine

Francesca Giannone, Cinzia Guarnaccia, Anna Maria Ferraro, Maria Rita Infurna, Salvatore Gullo


Outcomes – Process Connections: Alliance, Cohesion and Change in a Therapeutic Long Term Group

Research is currently moving in the direction of an integration between the outcome measures of the patients and the relational and/or structural factors that can facilitate their change. It is increasingly important to focus studies on the relationship between process and outcome, especially with regard to psychodynamic group therapy. These treatments, very complex and difficult to operationalize, still pose critical questions for research such as what are the main elements of the therapeutic process that are activated in these therapies?

Many efforts are to be made in understanding which factors develop in groups and the conditions that positively influence the success of therapy. Important is, moreover, the work of conceptual and "operational" depth on the different constructs, to better understand their nature and differences and build tools to more easily detect their features. Therapeutic alliance and cohesion are among the most investigated process variables, because of their role on the results of therapy. This study investigates these two variables in a therapeutic group with severe patients and analyzes their associations with treatment outcomes in term of symptoms and defenses. A long-term, semi-open group meeting on a weekly basis was examined. The observation was carried out for a period of 18 months, for a total amount of 50 sessions; 11 patients with different diagnoses in Axis I and II DSM IV were examined.

Outcome measures: SCL-90 - Symptom Check List; OQ-45 - Outcome Questionnaire 45.2; DSQ - Defense Style Questionnaire.

Process measures: CALPAS-G: California Psychotherapy Alliance Scale-Group; GMLCS: Group/Member/Leader Cohesion Scale.

The observation period was divided into 3 phases according to re-modulations of the setting (new entries, overcomes, dropout).

Significant correlations between alliance, cohesion and outcomes were found in the three phases. During the phase of greater instability, the predominant role of cohesion and, more generally, dimensions related to group commitment emerge.

Results offer interesting suggestions about the differentiation between Alliance and Cohesion and their different relationship with outcomes and process evolution.


Psychodynamic long-term group, therapeutic alliance, group cohesion, outcome-process research

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